News & Stories: 2008-09

January Series 2009: A new model for African AIDS research January 16, 2009

Helen Epstein, with a doctorate in molecular biology and a master’s degree in public health in developing countries used what she called a ‘cartoon’ to explain the AIDS pandemic in southeast Africa: an area of 12 countries that reports nearly half of the world’s cases of HIV.

A cartoon analogy

The cartoon used by Epstein, author of three New York Times best-sellers, was simply a group of human stick figures connected by lines. It looked much like a family tree. It showed the inner-connectivity of a group of people through polygamous relationships. If just one member of that group decided to add a partner and that partner carried the HIV virus, the entire network could very quickly become infected. Epstein described this situation as the “on-ramps that feed the [AIDS] superhighway.”

Long-term concurrency

Epstein used the Masai people from Kenya and northern Tanzania to illustrate her point. She said that in this culture, the men are polygamous and that it is not uncommon for a 40-year old man to have three wives, all of progressively younger ages. A couple of those wives, however, might have a boyfriend on the side. If only one of these boyfriends has the HIV virus, everyone from within this network will become infected quite rapidly.

Promiscuity–a solution?

She suggested that the idea of serial monogamy or promiscuity–having a succession of sexual partners–breaks up these networks, making the spread of HIV much more difficult. “Not until these two break-up and move onto other partners can the virus spread,” she said. Epstein went on to say that a group practicing ‘long-term concurrency’ will spread the virus 10 times faster than a group practicing ‘serial monogamy.’ She came to these conclusions after doing extensive research beginning in the early 1990’s in Uganda.

The root of the problem

Epstein talked openly about how external solutions to the AIDS pandemic in Africa– campaigns focused on condom use and abstinence–have simply missed the mark. “They spread the same message … that AIDS is for irresponsible people, people that make mistakes.” She recommends that people need to recognize the enemy is not the people with AIDS themselves, but the virus. She quoted a friend who is an AIDS worker in Tanzania: “If people know you care for them, you can be quite open.” Epstein added: “People can change. People change all the time, but they change in their own ways. You can’t just push a button.”